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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602961
Report Date: 04/16/2024
Date Signed: 04/17/2024 08:14:47 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/12/2024 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20240412120217
FACILITY NAME:BEARING LANE HOME CAREFACILITY NUMBER:
374602961
ADMINISTRATOR:JENKINS, VALERIEFACILITY TYPE:
735
ADDRESS:190 BEARING LANETELEPHONE:
(619) 749-4629
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:4CENSUS: 3DATE:
04/16/2024
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Licensee Valerie JenkinsTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff physically abused client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to initiate an investigation on the above-mentioned allegation. LPA identified herself and discussed the purpose of the visit with Assistant Administrator Christi De Leon. Licensee Valerie Jenkins arrived shortly after.

On April 12, 2024, Community Care Licensing (CCL) received a complaint alleging Staff 1 (S1) physically abused Client 1 (C1). During the investigation, LPA Strong collected pertinent client records as well as facility documentation and conducted interviews.

According to allegation, on April 3, 2024, C1 had an emotional episode that resulted in S1 grabbing client by the arm resulting in C1 having back pain. According to C1’s Physician Report C1 has no impairments and can communicate need. Additional records revealed C1 has a history of fabrication. Interview with clients present on the date of the incident did not confirm S1 injured C1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20240412120217
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: BEARING LANE HOME CARE
FACILITY NUMBER: 374602961
VISIT DATE: 04/16/2024
NARRATIVE
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Interview without Outside Source 1 (OS1) revealed that there was no visible injury on C1. Interview with Outside Source 2 (OS2) established that S1 had no intention of harming C1 and was only attempting to redirect C1. Interview with C1 revealed C1 feels safe at facility. Interview with S1 revealed S1 was attempting to redirect client during an emotional episode and S1 followed intervention training. Records reviewed revealed S1 has crisis intervention training.

Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Licensee to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2